Treating Macular Degeneration: Early Detection Can Preserve Sight

Northern Illinois Retina is a community leader in treating patients with macula- and retina-related eye conditions. Learn some of the signals that often indicate degeneration.

Dr. Susan Fowell, of Northern Illinois Retina, in Rockford, specializes in care and surgery for those affected by retina and macula-related conditions.

For nearly 25 years, Northern Illinois Retina, 1235 N. Mulford Road, in Rockford, has provided care and surgery to those who are afflicted with diseases related to the macula and the retina.

“Our practice is limited to the diagnosis and treatment of diseases affecting the back portion of the eye,” says Dr. Susan Fowell, an ophthalmologist who has completed fellowship training in both medical and surgical treatments for diseases of the retina, macula and vitreous. “Some of the more common diseases we treat include diabetic retinopathy, macular degeneration, macular wrinkling and holes, ocular trauma, retinal tears, detachment and retinal vascular disorders.”

Age-related macular degeneration (ARMD) is one of the most common causes of poor vision after age 65. ARMD is the result of deterioration of the tissues in and around the macula, a small area in the center of the retina, at the back of the eye, that allows people to see fine details and perform activities such as reading and driving. The visual symptoms of ARMD involve loss of central vision. A patient’s peripheral vision is usually unaffected.

ARMD seems to be related to the aging process, says Fowell, but risk factors may also include heredity, blue eyes and fair complexions, uncontrolled high blood pressure, cardiovascular disease and a history of smoking. ARMD accounts for 90 percent of new cases of legal blindness in the United States, which is defined as visual acuity equal to or poorer than 20/200 in the best-seeing eye.

Fowell points out that nine out of 10 people with ARMD have the atrophic, or “dry” type, which manifests as the development of yellow spots under the retina (drusen), pigment epithelial atrophy, and clumping. Dry ARMD typically progresses very slowly but can be a significant cause of central visual loss. The good news, Fowell says, is that a specific vitamin regimen has been shown to slow the progression of dry ARMD. Other medications, called complement inhibitors, are being developed which may slow the progression of dry ARMD. Currently, no complement inhibitors are available clinically because they’re still in the FDA approval process.

Exudative ARMD, or “wet” ARMD, is less common, occurring in one out of 10 patients. Fowell says the wet form is more serious because abnormal blood vessels grow beneath the retina, leaking fluid and blood, and creating the symptom of visual distortion that can lead to the development of a blind spot in the center of the patient’s vision.The most important prognostic factor in wet ARMD, says Fowell, is early detection. When discovered early, wet ARMD leaves behind less scarring and fibrosis, and smaller lesions.

Many patients are unaware of changes in their vision, says Fowell. One way to detect ARMD early is to cover one eye and look at a print of an Amsler grid or a larger repeating pattern, such as window blinds or grout lines on a tiled floor. By comparing the perception of one eye with the other, patients may be able to detect the onset of distortion fairly early.

In the past, treatment for ARMD included thermal laser, a burn that cauterized the leaking blood vessels but also left a permanent scar. Another early treatment was photodynamic therapy, or cool laser, which caused less scarring. Fowell says both of these laser treatments now have a limited role in certain cases, and are largely supplanted by the injection of vascular endothelial growth factor inhibitors directly into the eye. These injections suppress the leakage and growth of existing abnormal blood vessels.

Because these medicines are “biologics,” monthly treatments are required until the abnormal blood vessels stabilize, and thus, stop leaking and scarring. Visual outcomes can be good if treatment is initiated early in the disease process, says Fowell.

If the disease is caught later, scarring can limit the treatment’s success.

Early detection, especially in the first eye, is vitally important, Fowell reiterates.

There is hope for patients diagnosed with ARMD. Fovista, a drug now in the FDA pipeline, may stop leakage but also limit scarring and fibrosis, says Fowell. Plus, it can cause established abnormal vessels to regress, thus shrinking the network of abnormal new sub-retinal blood vessels.

Promising ARMD research is being done on many fronts, Fowell says. In the meantime, high-intensity reading lamps, magnifiers that work well when the involved area of the macula is small, and other low-vision aids help patients to make the most of their remaining vision.

Northern Illinois Retina began its practice in offices on East State Street in Rockford, but in January 2015 relocated to Mulford Road, to better serve its patients. With exclusivity in her field of treatment, Fowell treats a growing number of patients who rely upon her knowledge and experience to overcome retinal diseases.

“Our practice is proud of the rapport we have developed with our patients since 1991,” Fowell says. “We are committed to providing our patients with compassionate care and the latest treatment options.”

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